Are There Any Additional Charges in Memory Care Facilities on Top of Medicaid?

There may be additional charges in memory care facilities on top of what Medicaid pays, depending on state Medicaid guidelines, an individual’s care needs and financial situation, a facility’s policies and the care setting. Additionally, not all memory care communities accept Medicaid. Some memory care facilities operate as stand-alone units, while others are within assisted living communities, continuing care communities or nursing homes.

Not every individual automatically qualifies for Medicaid for memory care services. However, there are several options for paying for memory care; individuals may be eligible for other funding to reduce their out-of-pocket expenses, and there may be ways to free up property equity to help cover costs.

Low-income seniors with dementia who reside in nursing homes may qualify for full funding through traditional Medicaid, including room and board. Typically, individuals who are eligible for a nursing home level of care but choose to remain in a community setting, such as a stand-alone memory care facility or a memory care unit in an assisted living facility, may qualify for financial assistance via waivers to cover care and support services but don’t receive funding for their rooms or meals.

Individuals who are refused financial aid because of excess income may be able to offset medical bills in a process known as spend down to qualify for public assistance. Because Medicaid rules are complex, individuals or their loved ones should seek professional guidance from their local Area Agency on Aging or Aging and Disability Resource Center.

When Medicaid covers partial costs for memory care communities, individuals must compensate for shortfalls. Options may include self-pay options, such as selling assets or using savings, long-term care insurance, VA benefits and reverse mortgages. Additionally, in some care settings, individuals may need to pay for enhanced services.

Even when Medicaid covers full memory care costs, individuals may still have additional charges. Examples may include nonmedical transportation, excursions, special activities, salon services and (setting dependent) pet fees. Seniors or their family members often bear the costs of nonessential services or amenities.